Healthcare Provider Details

I. General information

NPI: 1356544159
Provider Name (Legal Business Name): DIRECT MEDICAL TESTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 I-45 NORTH FREEWAY STE# 208
HOUSTON TX
77022
US

IV. Provider business mailing address

4615 I-45 NORTH FREEWAY STE# 208
HOUSTON TX
77022
US

V. Phone/Fax

Practice location:
  • Phone: 713-695-6200
  • Fax:
Mailing address:
  • Phone: 713-695-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JAMES COSTELLO
Title or Position: DOCTOR
Credential:
Phone: 713-695-6200